The changes within the state budget include new protections that give people advanced warning of the higher bills.

An independent review board also will be able to determine whether health insurers acted appropriately when charging out-of-network rates. Along with other duties, the board could reduce someone's bill because an in-network doctor was unavailable.

Robert Hinckley, a senior vice president at CDPHP, an Albany health insurer, said the out-of-network protections could increase costs, but the impact would be more severe if the state required the coverage in plans sold on the exchange.

"The best thing is that there isn't a tremendous amount of change (in 2015)," he said, noting it will take at least two years of crunching insurance data to properly implement ACA exchanges.

Kyle Rogers, of HealthNow New York, a regional health insurer that includes the Capital Region, had a similar take on the out-of-network protections.

"We're still determining what impact this will have," he said.

As for the 2014 exchange, the Capital Region's three largest health insurers -- MVP Health Care, CDPHP, and HealthNow New York -- joined others across the state in selling coverage.

The three insurers combined added about 35,000 new members in the 11-county Capital Region, though that is a fraction amount of their total membership of about 2 million.

Even more people, including in New York, are expected to buy coverage on exchanges in 2015, following the uncertainties surrounding the inaugural enrollment under the politically charged ACA.

Still, this year saw more than 8 million people buy coverage nationally, with President Barack Obama touting the better-than-expected 2014 enrollment as a sign the federal law is working.

Long-term ACA goals include reducing the number of people without insurance, or the uninsured rate, and driving down costs by increasing competition among health insurers.

While some details still remain unclear, New York definitely outperformed most other states in terms of selling insurance plans on its exchange, named New York State of Health.

Many states relied on federally-run exchanges, in which the federal government oversees the marketplace. That was a default option under the ACA for states refusing to run their own exchange.

New York's exchange will begin 2015 open enrollment on Nov. 2 for small businesses and Nov. 15 for individuals and families, according to the state Department of Health.